Putting in a sewage lift station inside my house and want to run a 220 volt pump. Now I know how to run pill switch for 110 volt power but how does the pill switch work when both legs a hot?

Not sure what a "pill" switch is, perhaps a pressure switch?

Any switch controlling 240 volts must be a two pole switch rated 240 volts.

There will be four terminals, two for the 240 line input from the source, and two for the 240 volt output to the motor.

Be sure to ground the frame of the switch with the bare or green equipment grounding conductor. There will be a green screw on the switch for this ground wire.

You should wire the pill switch the same as you would if it were 110, it will work exactly the same. All you have to do to control a circuit is be able to cause an interupption of current in the circuit, switching one hot leg on a 220 will do just that.